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CDC 24/7: Saving Lives. Protecting People.CDC 24/7: Saving Lives. Protecting People. Quick-Learn Lesson Recognizing the Biosafety Levels (for CNE)
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 Recognizing the Biosafety Levels (for CNE) This Quick Learn Lesson will take approximately 15 minutes to complete. When you have completed this lesson, you will be able to identify characteristics of the four biological safety levels.
 Introduction Suppose you are a laboratory microbiologist working with a potentially harmful microbe. Precautions must be taken in the laboratory to make sure you and others are not infected. Where in the lab would you complete your work?
	What protective equipment and practices would you use?
	How would you contain the microbe to limit contamination or accidental infection? These are just a few of the questions that can be answered through an understanding of biosafety and the four biosafety levels (BSLs). **Microbe** Microbes are organisms, such as bacteria and viruses that are too small to be seen by the naked eye.
 Biosafety and Biosafety Levels **What is Biosafety?** 
									Biosafety is the application of safety precautions that reduce a laboratorian’s risk of exposure to a potentially infectious microbe and limit contamination of the work environment and, ultimately, the community. **What are Biosafety Levels (BSLs)?**
There are four biosafety levels. Each level has specific controls for containment of microbes and biological agents. The primary risks that determine levels of containment are infectivity, severity of disease, transmissibility, and the nature of the work conducted. Origin of the microbe, or the agent in question, and the route of exposure are also important. Each biosafety level has its own specific containment controls that are required for the following: Laboratory practices
	Safety equipment
	Facility construction **Route of Exposure** Route of exposure is the way a microbe gains access to a living organism. There are four main routes of exposure Percutaneous, though broken or damaged skin
	Inhalation
	Mucous membranes of the eyes, nose, and mouth
	Ingestion
 BSLs, continued The biosafety levels range from BSL-1 to BSL-4. Each biosafety level builds on the controls of the level before it. Every microbiology laboratory, regardless of biosafety level, follows standard microbiological practices.    You will learn about each level on the following screens. **Standard Microbiological Practices** Standard microbiological practices are those practices that are common to all laboratories. These practices may include Not eating, drinking, or applying cosmetics in the lab 
	Washing hands after working with infectious materials and before leaving the lab
	Routinely decontaminating work surfaces
 BSL-1    If you work in a lab that is designated a BSL-1, the microbes there are not known to consistently cause disease in healthy adults and present minimal potential hazard to laboratorians and the environment. An example of a microbe that is typically worked with at a BSL-1 is a nonpathogenic strain of *E. coli*. Specific considerations for a BSL-1 laboratory include the following: Laboratory practices Standard microbiological practices are followed.
	Work can be performed on an open lab bench or tableA. Safety equipment Personal protective equipmentB, (lab coats, gloves, eye protection) are worn as needed. Facility construction A sink must be available for hand washing.
	The lab should have doors to separate the working space with the rest of the facility.Man working in a BSL-1 lab wearing a lab coat, safety glasses, and gloves while pouring liquid into a beaker on an open lab bench. **Nonpathogenic** A nonpathogenic microbe is one that is not capable of causing disease.
 **Personal Protective Equipment (PPE)** Equipment worn to minimize exposure to a variety of hazards. Examples of PPE include laboratory coats, gowns, gloves, eye protection, face shields, shoe covers, and respirators.
 BSL-2    BSL-2 builds upon BSL-1.  If you work in a lab that is designated a BSL-2, the microbes there pose moderate hazards to laboratorians and the environment.  The microbes are typically indigenous and associated with diseases of varying severity. An example of a microbe that is typically worked with at a BSL-2 laboratory is *Staphylococcus aureus*. **Indigenous** Indigenous microbes are those that are commonly found in the geographic region.
 BSL-2, continued In addition to BSL-1 considerations,  BSL-2 laboratories have the following containment requirements: Laboratory practices Access to the laboratory is restricted when work is being conducted. Safety equipment Appropriate personal protective equipment (PPE) A is worn, including lab coats and gloves.  Eye protection and face shields can also be worn, as needed. 
	All procedures that can cause infection from aerosols or splashes are performed within a biological safety cabinet (BSC)B.       
	An autoclave or an alternative method of decontamination is available for proper disposals. Facility construction The laboratory has self-closing doors.
	A sink and eyewash are readily available.Woman working in a BSL-2 laboratory. She is wearing gloves, a face shield, a lab coat and is conducting work within a biological safety cabinet. **Autoclave** Equipment used to decontaminate biological hazardous waste or to sterilize equipment and supplies by subjecting them to high pressure and saturated steam
 **Biological Safety Cabinet (BSC)** A ventilated cabinet designed to provide personnel, product, and environmental protection when appropriate practices and procedures are followed
 **Eyewash** An apparatus used to physically wash the eyes if they are contaminated by infectious microbes, foreign materials, or other substances
 **Face Shields** A protective device commonly used to shield the wearer's face and eyes from hazards such as the splashing, spraying, or splattering of potentially harmful infectious materials
 BSL-3    BSL-3 builds upon the containment requirements of BSL-2. If you work in a lab that is designated BSL-3, the microbes there can be either indigenous or exotic, and they can cause serious or potentially lethal disease through respiratory transmission. Respiratory transmission is the inhalation route of exposure. One example of a microbe that is typically worked with in a BSL-3 laboratory is *Mycobacterium tuberculosis*, the bacteria that causes tuberculosis.
 BSL-3, continued In addition to BSL-2 considerations,  BSL-3 laboratories have the following containment requirements: Laboratory practices Laboratorians are under medical surveillance and might receive immunizations for microbes they work with.
    Access to the laboratory is restricted and controlled at all times. Safety equipment Appropriate PPE must be worn, and respirators might be requiredA. 
	All work with microbes must be performed within an appropriate   BSCB. Facility construction A hands-free sink and eyewash are available near the exit.
	Exhaust air cannot be recirculated, and the laboratory must have sustained directional airflow by drawing air into the laboratory from clean areas towards potentially contaminated areas.
    Entrance to the lab is through two sets of self-closing and locking doorsC.Man working in a BSL-3 lab wearing PPE, including a powered air purifying respirator. He is working within a BSC. Self-closing locked doors are in the background of the work station. **Respirator** A protective device that covers the nose and mouth or the entire face or head.  Lab respirators filter out infectious or harmful particles; some supply the wearer with HEPA-filtered air. Appropriate respirators are chosen based on the type of work being performed.
 BSL-4    BSL-4 builds upon the containment requirements of BSL-3 and is the highest level of biological safety. There are a small number of BSL-4 labs in the United States and around the world. The microbes in a BSL-4 lab are dangerous and exotic, posing a high risk of aerosol-transmitted infections. Infections caused by these microbes are frequently fatal and without treatment or vaccines. Two examples of microbes worked with in a BSL-4 laboratory include Ebola and Marburg viruses.
 BSL-4, Continued In addition to BSL-3 considerations,  BSL-4 laboratories have the following containment requirements: Laboratory practices Change clothing before entering.
    Shower upon exiting.
    Decontaminate all materials before exiting. Safety equipment All work with the microbe must be performed within an appropriate Class III BSC , or by wearing a full body, air-supplied, positive pressure A suit. Facility construction The laboratory is in a separate building or in an isolated and restricted zone of the building.
	The laboratory has dedicated supply and exhaust air, as well as vacuum lines and decontamination systems.Woman working in a BSL-4 laboratory. She is wearing a full positive pressure suit. No skin is exposed; her air supply can be seen on the back of her suit. She working within a BSC. **Class III BSC** A gas-tight sealed container that is designed to allow for the manipulation of objects, hazardous substances, or infectious disease agents. Class III BSCs have a HEPA filtered air supply and double HEPA filtered exhaust.  They provide the ultimate protection for personnel, product, and the environment.
 **Positive Pressure Protective Suit** Highly specialized, totally encapsulating industrial protection garments worn only within special biocontainment or maximum containment (BSL-4) laboratory facilities. The positive pressure in the suit will force air to flow out if the suit is damaged.
 Your Turn: Exercises Now that you have learned about the four biosafety levels, it's your turn to identify the correct BSL in the examples on the following screens. Select the Next icon to begin.
 Your turn: Exercise 1 Select the biosafety level described by the conditions of the following example. Levels are listed below. A microbiology graduate student is working on a project under the following conditions: Work is conducted on a standard laboratory table or bench.
                                            A nonpathogenic laboratory strain of *E. coli* is being used.
                                            Minimal PPE, such as a lab coat, gloves, and eye protection might be worn but are not necessary. BSL-1 BSL-2 BSL-3 BSL-4 **Exercise 1: Correct** That is **correct**!
This example suggests a BSL-1 laboratory where there is minimal risk of infection. A nonpathogenic strain of *E. coli* is being used, and work is conducted on a standard laboratory bench. Special PPE and facility construction are not necessary.
 **Exercise 1: Incorrect** That is **incorrect**!The correct answer is BSL-1.
This example suggests a BSL-1 laboratory where there is minimal risk of infection. A nonpathogenic strain of *E. coli* is being used, and work is conducted on a standard laboratory bench. Special PPE and facility construction are not necessary.
 **Exercise 1: Incorrect** That is **incorrect**!The correct answer is BSL-1.
This example suggests a BSL-1 laboratory where there is minimal risk of infection. A nonpathogenic strain of *E. coli* is being used, and work is conducted on a standard laboratory bench. Special PPE and facility construction are not necessary.
 **Exercise 1: Incorrect** That is **incorrect**!The correct answer is BSL-1.
This example suggests a BSL-1 laboratory where there is minimal risk of infection. A nonpathogenic strain of *E. coli* is being used, and work is conducted on a standard laboratory bench. Special PPE and facility construction are not necessary.
 Your turn: Exercise 2 Select the biosafety level shown in the photo below. Click on the photo for a larger image. BSL-1 BSL-2 BSL-3 BSL-4  Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 2: Incorrect** That is **incorrect**!
The correct answer is BSL-3.
This photograph suggests a BSL-3 laboratory. The laboratorian is working within a BSC and is wearing a powered air purifying respirator, gloves, and a solid-front gown.
 **Exercise 2: Incorrect** That is **incorrect**!
The correct answer is BSL-3.
This photograph suggests a BSL-3 laboratory. The laboratorian is working within a BSC and is wearing a powered air purifying respirator, gloves, and a solid-front gown.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 2: Correct** That is **correct**!
This photograph suggests a BSL-3 laboratory. The laboratorian is working within a BSC and is wearing a powered air purifying respirator, gloves, and a solid-front gown.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 2: Incorrect** That is **incorrect**!
The correct answer is BSL-3.
This photograph suggests a BSL-3 laboratory. The laboratorian is working within a BSC and is wearing a powered air purifying respirator, gloves, and a solid-front gown.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 Your turn: Exercise 3 Select the biosafety level described by the conditions of the following example. Levels are listed below. Work is conducted on a standard laboratory bench in a contained area. 
											
											PPE, including a lab coat, gloves, and eye protection are being used to reduce accidental infection. BSL-1 BSL-2 BSL-3 BSL-4 **Exercise 3: Incorrect** That is **incorrect**!
The correct answer is BSL-2.
This scenario suggests a BSL-2 laboratory. The laboratorian is working with a pathogenic strain of *Staphylococcus*, which poses moderate risk of infection. Work is conducted on a standard laboratory bench within a contained area, and the laboratorian is wearing appropriate PPE to reduce the risk of accidental infection.
 **Exercise 3: Correct** That is **correct**!
This scenario suggests a BSL-2 laboratory. The laboratorian is working with a pathogenic strain of *Staphylococcus*, which poses moderate risk of infection. Work is conducted on a standard laboratory bench within a contained area, and the laboratorian is wearing appropriate PPE to reduce the risk of accidental infection.
 **Exercise 3: Incorrect** That is **incorrect**!
The correct answer is BSL-2.
This scenario suggests a BSL-2 laboratory. The laboratorian is working with a pathogenic strain of *Staphylococcus*, which poses moderate risk of infection. Work is conducted on a standard laboratory bench within a contained area, and the laboratorian is wearing appropriate PPE to reduce the risk of accidental infection.
 **Exercise 3: Incorrect** That is **incorrect**!
The correct answer is BSL-2.
This scenario suggests a BSL-2 laboratory. The laboratorian is working with a pathogenic strain of *Staphylococcus*, which poses moderate risk of infection. Work is conducted on a standard laboratory bench within a contained area, and the laboratorian is wearing appropriate PPE to reduce the risk of accidental infection.
 Your turn: Exercise 4 Select the biosafety level shown in the following photograph below.  Click on the photo for a larger image. BSL-1 BSL-2 BSL-3 BSL-4  Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 4: Incorrect** That is **incorrect**!
The correct answer is BSL-4.
This image suggests a BSL-4 laboratory. The scientist is working within a BSC. He is wearing a full-body, air-supplied, positive pressure protective suit.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 4: Incorrect** That is **incorrect**!
The correct answer is BSL-4.
This image suggests a BSL-4 laboratory. The scientist is working within a BSC. He is wearing a full-body, air-supplied, positive pressure protective suit.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 4: Incorrect** That is **incorrect**!
The correct answer is BSL-4.
This image suggests a BSL-4 laboratory. The scientist is working within a BSC. He is wearing a full-body, air-supplied, positive pressure protective suit.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 **Exercise 4: Correct** That is **correct**!
This image suggests a BSL-4 laboratory. The scientist is working within a BSC. He is wearing a full-body, air-supplied, positive pressure protective suit.Man is wearing a powered air purifying respirator, gloves, and solid-front gown. He is working within a BSC, and self-closing, locked doors are in the background.
 Summary **Congratulations**! You should now be able to identify characteristics of the four biological safety levels. Select the Next icon to view additional resources on biosafety and to obtain instructions for how to apply for CNE. 
To view other Quick Learn Lessons, visit CDC Learning Connection.
 Resources For more information on biosafety and laboratory practice, review the following web resources: Biosafety in Microbiological and Biomedical Laboratories (5th Edition)
									Biosafety — Centers for Disease Control and Prevention
									Respirator Fact Sheet
									Instructions to apply for CNE
 CDC Learning Connection LogoFor more Quick-Learn lessons please visit CDC Learning Connection
 Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
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